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Tissue accumulation
1. Tissue deposits (Tissue
Accumulations)
By
Dr/ Rana “M. ElSaid” Abou-ElFetouh Abdalla
Lecturer of pathology
MD., DipRCPath
Pathology Department.
Official email: rana.elsaied@fmed.bu.edu.eg
2. Instructor information
Dr/ Rana “M. ElSaid” Abou-ElFetouh Abdalla
Lecturer of pathology
MD., DipRCPath
Pathology Department.
Official email: rana.elsaied@fmed.bu.edu.eg
3. Learning
Outcomes
By the end of the lecture, the students will be able to:
1- classify tissue accumulations.
2-outline the difference between endogenous and
Exogenous pigmentation.
3-highlight the difference between types of abnormal
calcification (Dystrophic calcification, metastatic
calcification)
4- explain the pathogensis of heamochromatosis
5-Identify the different types of amyloidosis
(classification), the causes of its deposition and its
distribution in the different body organs
4. Case
• Mrs Lamiaa, a 40-year old female patient,
came to the clinic c/o lower limp swelling and
SOB on exertion gradually increasing over the
past 2 months.
• The medical records revealed that she was
diagnosed with Mediterranean-sea fever 10
years ago. She reported neglecting her
medications and reported obvious decrease in
her urine output.
• On examination, generalized edema was
observed. Renal function tests were requested
and came up altered.
• Renal biopsy was ordered.
8. II-Protein deposition (hyalinosis)
Definition: It is alterations of intracellular proteins to
appear as cytoplasmic homogenous rounded eosinophilic
globules in hematoxyline and eosin stained sections.
Examples:
1. Russell’s bodies: In a disease named Rhinoscleroma
(intracellular)
2. In proximal convoluted tubules of the kidney: In cases
of proteinuria.(intra & extra cellular)
3. Mallory bodies: in alcoholic cirrhosis (intracellular).
9. III- Carbohydrates
A- Glycogen
a group of diseases
called glycogen storage
diseases.
Etiology: due to abnormal
glycogen metabolism
Microscopically: the cells
are swollen with clear
cytoplasmic vacuoles
B. Mucin (Mucoid or Mucinous
Degeneration):
mucin hypersecretion
Examples:Catarrhal
inflammation - Mucoid
carcinoma
Microscopically:
• cells distended with
mucin
• signet-ring cell-
• The cells may rupture
with release of mucin
(mucin lackes)
10. IV- pigments
exogenous
1-Inhalation :
• Anthracosis: carbon
• Silicosis: In cool miners,
silica
2-Injection : TattooingColored
dye (India ink)
3-Ingestion :
• Plumbism (lead poisoning
as a blue line on gums.
• Argyria (Silver poisoning):
Gray coloration of the skin,
endogenous
1- Melanin.
2- Lipofuscin.
3- Hemoglobin
(hemosiderin).
13. B- Lipofuscin pigment (Liopchrome
pigment
• Brown or yellow pigments
• particularly prominent in
the liver and heart of aging
patients
• not injurious to the cell or
its functions
• due to tear and wear →
Tissue breakdown →
Release of phospholipids →
Phagocytosed by the
healthy neighboring cells →
Intracellular accumulation
of lipofuscin pigment →
Brownish coloration.
14. c- Hemosiderin
a hemoglobin-derived, golden yellow to-brown, granular or
crystalline pigment derived from iron
• Local excesses of hemosiderin
• Common bruise
• Systemic overload of iron -
HEMOSIDEROSIS
❖ 1ry Hemochromatosis
(Bronzed Diabetes )
❖ 2ry Hemochromatosis
• Hemolytic anemias
• Repeated blood transfusions
15.
16.
17. V- Calcium
Pathologic calcification is the abnormal tissue deposition of calcium
salts, together with smaller amounts of iron, magnesium, and other
mineral salts
18. Types
❖ Dystrophic
• deposition occurs locally in dying tissues
• it occurs despite normal serum levels of calcium
• In absence of derangements in calcium metabolism
❖ Metastatic
• deposition of calcium salts in otherwise normal tissues
• results from hypercalcemia
• secondary to some disturbance in calcium metabolism.
❖ Calcinosis. Rare type of pathological calcification of
unknown cause.
❖ Stone formation. Calcium salts deposition in the cavities
of hollow organs as urinary and biliary tracts stone
19. Dystrophic calcification
➢ Degenerated or necrotic
tissue
➢ Examples
• in the atheromas of
advanced atherosclerosis
• develops in aging or damaged
heart valves
Metastatic calcification
Causes
• hyperparathyroidism
• Resorption of bone tissue e.g
➢ primary tumors of bone
marrow (e.g., multiple
myeloma
➢ diffuse skeletal metastasis
(e.g., breast cancer),
➢ accelerated bone turnover
(e.g., Paget disease)
➢ Immobilization
• Vitamin D–related disorders
• Renal failure
22. Amyloidosis
• Definition: Extracellular deposition of homogenous hyaline
eosinophilic amyloid material (abnormal protein).
Classification of amyloidosis:
❑ Localized
❑ Systemic (generalize)
I-1ry amyloidosis… immunocytic derived AL type
II-2ry amyloidosis… reactive amyloid (SAA)
III-Haemodialysis-associated amyloidosis (B2-microglobulin)
IV-Heredofamilial amyloidosis (Transthyretin)
23.
24.
25. Primary (AL)
➢ unknown etiology,
which may be due to:-
Colonal expansion of
immunocyte
proliferation
➢ Organs affected:
Myocardium – Intestine
- Esophagus - skin-
Peripheral nerves - May
be also in solid organs
as Kidney
Secondary (AA)
➢ due to:
• Chronic Inflammations.
• Autoimmune Diseases
• Malignant Tumor
➢ It particularly affects
the parenchymatous
organs as:
- Kidneys - Liver- Spleen -
Lymph nodes - May be
intestine and heart.
26. Haemodialysis associated
amyloidosis
• Occur in 70% of
patients with chronic
renal failure subjected
to chronic
hemodialysis.
• Deposition of B2-
microglobulin protein.
Heredofamilial amyloidos
• an inherited condition
that may be
characterized by
systemic or localized
deposition
of amyloid in body
tissues
• Mutant TTRs
• Ppt in nerves
27. Localized amyloidosis
a- Endocrine associated amyloidosis:
- In medullary carcinoma of thyroid
- In pancrease causing D.M
b- Senile amyloid :
➢In old age amyloid material (transthyretin)
may be deposited exatracellulary in between
cardiac muscle fibers.
➢In brain (Alzheimer’s disease)
28.
29. Amyloidosis
Diagnosis
Tissue biopsy :
• Congo red ……..orange
• By polarized light
……apple green color
Treatment
• No treatment available
• Organ transplantation
30. Back to the case
• name the possible diagnosis
• Classify the disease in this case
• Name a stain could be useful in
confirming your diagnosis
• Describe the prognosis for
32. An 84-year-old man dies. At autopsy, his heart is
small and dark brown on sectioning.
Microscopically, there is light brown perinuclear
pigment Which of the following substances is
mostly the cause?
A Hemosiderin from iron overload
B Lipochrome from 'wear and tear'
C Glycogen from a storage disease
D Cholesterol from atherosclerosis
E Calcium deposition following necrosis
33. A 48-year-old woman has a malignant lymphoma. She is
treated with a chemotherapeutic agent which results in
the loss of individual neoplastic cells through
fragmentation of individual cell nuclei and cytoplasm.
Over the next 2 months, the lymphoma decreases in
size. By which of the following mechanisms has her
neoplasm primarily responded to therapy?
A Coagulative necrosis
B Mitochondrial poisoning
C Phagocytosis
D Acute inflammation
E Apoptosis
34. A 22 year-old woman has congenital anemia that
has required multiple transfusions of RBCs for many
years. Which of the following findings would most likely
appear in a liver biopsy specimen?
A. Steatosis in hepatocytes
B. Bilirubin in canaliculi
C. Glycogen in hepatocytes
D. Amyloid in the liver
E. Hemosiderin in hepatocytes
